Provider Demographics
NPI:1528312741
Name:FALLAH, MICHELLE N (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:N
Last Name:FALLAH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WATERWORKS WAY STE 245
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3175
Mailing Address - Country:US
Mailing Address - Phone:949-299-9596
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY STE 245
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3175
Practice Address - Country:US
Practice Address - Phone:949-299-9596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94021931103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist